Geriatrics Flashcards
(25 cards)
Alzheimer’s management
Donepezil
Galantamine
Rivastigmine
Memantine second line
Donezepil, galantamine, rivastigmine class of drug
Anticholinesterase inhibitors
Memantine class of drug
NMDA receptor antagonist
Donepezil contraindications and adverse effects
C/I in bradycardia
Can cause insomnia
Alzheimer’s risk factors
Apoprotein e allele E4
Caucasian
Downs
Autosomal dominant cases- amyloid precursors chromo 1, 14, 21
Alzheimer’s pathological changes
Widespread cerebral atrophy
Cortical plaques due to type a beta amyloid protein and neurofib tangles from excessively phosphorlyated tau
Acetylcholine deficit
Features of frontotemporal lobar dementias
Onset before 65
Insidious onset
Relatively preserved memory and visuospatial skills
Personality changes and social conduct problems
Types of frontotemporal dementia
Picks
Progressive non fluent aphasia
Semantic dementia
Focal gyral atrophy with knife blade appearance
Picks disease
Features of picks disease
Personality change
Impaired social conduct
Hyperorality
Disinhibition
Increased appetite
Perseveration behaviours
Microscopic changes in pick disease
Pick bodies (spherical aggregations of tau)
Gliosis
Neurofibrillary tangles
Senile plaques
Managing frontotemporal dementia
Do not use acetylcholinesterase Inhibitor or memantine
Chronic progressive aphasia features
Non fluent speech
Short utterances
Relatively preserved comprehension
Semantic dementia
Fluent progressive aphasia
Speech fluent but conveys little meaning
Memory is better for recent events
What are lewy bodies and where are they?
Alpha synucliein cytoplasmic inclusions
Substantia Nigra, paralimbic, neocortical
Features of lewy body dementia
Progressive cognitive impairment occurs before Parkinsonism
Cognition may fluctuate
Early impairments in attention and executive function
Parkinsonism
Visual hallucinations
Diagnosing Lewy body dementia
Spect
Uses 123-I FP-CIT radioisotope
Neuroleptics and Lewy body
Avoid as they may develop irreversible parkinsonism
Grade 2 pressure ulcer
Partial thickness skin loss
Superficial ulcer
Grade 3 pressure ulcer
Full thickness skin loss
Damage or necrosis of subcutaneous tissue
May extent to but not through fascia
Grade 4 pressure ulcer
Extensive destruction, necrosis or damage to muscle, bone or supporting structures with or without full thickness skin losd
What is mixed dementia?
Vascular and alzheimers
Stepwise deterioration in cognition
Vascular dementia
NINDS AIREN criteria
For diagnosing vascular dementia
Cognitive decline not due to Cva
Cerebrovascular disease
Relationship between two above
